转移是癌症最致命的方面，常常在血管系统内形成肿瘤栓子（TT）之前。肾脏细胞癌（RCC）是最常见的肾癌形式，在4-10%的病例中发生静脉系统侵犯，导致静脉肿瘤栓子（RCC-TT）。这个变种由于手术复杂性增加、进展和转移的风险增加以及不良预后而成为临床上的难题。然而，近期针对RCC-TT的临床试验面临重大障碍，包括深层次和肿瘤内部异质性、个体化治疗差异以及原发肿瘤（PT）和TT之间不同的治疗抵抗模式。本综述研究了RCC-TT的独特进化途径、RCC-TT侵袭模式的分期和分级关系，以及RCC-TT的空间分子表达谱。另外，我们评估了TT、PT和远处转移之间的时序异质性，以及TME组分的功能表型。对未来关于RCC-TT的研究进行了展望。版权所有 © 2023 Elsevier B.V. 出版。

Metastasis is the most fatal aspect of cancer, often preceded by a tumor thrombus (TT) which forms within the vascular system. Renal cell carcinoma (RCC), the predominant form of kidney cancer, witnesses a venous system invasion in 4-10% of cases, resulting in venous tumor thrombus (RCC-TT). This variant represents a formidable clinical challenge due to its escalated surgical complexity, heightened risk of progression and metastasis, and an adverse prognosis. However, recent trials addressing RCC-TT face significant barriers stemming from the profound inter- and intra-tumoral heterogeneity, patient-specific treatment variations, and distinct therapeutic resistance patterns between the primary tumor (PT) and the TT. This review delves into the unique evolutionary pathway of RCC-TT, the relationship between the staging and grading of RCC-TT invasion patterns, and the spatial molecular profiling of RCC-TT. Additionally, we assess the temporal heterogeneity among TT, PT, and distant metastases, as well as the functional phenotypes of TME components. An outlook for future research on RCC-TT is also provided.Copyright © 2023. Published by Elsevier B.V.